monthly ma apcd / case mix user workgroup webinar july 28, 2015
TRANSCRIPT
Monthly MA APCD / Case Mix User Workgroup Webinar
July 28, 2015
Agenda
I. Announcements
II. Common Application Issues
III. CHIA Enrollment Trends Presentation
IV. User Questions
V. Q&A
Announcement2014 Case Mix Availability
• Inpatient data is available now• Emergency Department data is scheduled for
August• Outpatient data is schedule for September• You may apply for ALL files now and CHIA will fulfill
requests for the unavailable files as they become available.
AnnouncementNew Fee Waiver Provision
• As of June 1, 2015: • Payers, providers, and provider organizations that
are required to file data with the Center pursuant to MGL c. 12C and are current with all such data filings and reporting requirements may qualify for a Full or Partial Waiver
AnnouncementNew Fee Waiver Provision
Revised the Application Fee Remittance Form for APCD and Case Mix.
Request fee waivers on Page 2 of this form. The new provision is listed under Question #6.
Updated fee schedules:
APCD Fee Schedule
Case Mix Fee Schedule
ReminderMA APCD Application Processing
CHIA will only be accepting applications for MA APCD from Massachusetts payers and providers that submit APCD and Case Mix data, as well as Massachusetts-based students and researchers.• Applications from all others will not be accepted until
November 1, 2015• Applications submitted prior to May 13, 2015 will be
processed• Case Mix is not impacted
Common Application Issues and Questions
APCD Amendments
• An amendment request for additional MA APCD data elements must contain the following documents:
1) Amendment Request Form (which you can request from Adam Tapply)2) Specification Workbook showing which elements you need and your
justifications for each element
REMINDER: The specification workbook you submit must be from the same release of the data that you received(if you received Release 2.1, you must submit a 2.1 worksheet)
MEIDs for Subsequent Data Requests
• If you currently have data and are applying for a new year of data, you should request refreshes of all previous years of data that you received• New MEIDs are generated for each release(example: if you get Release 3.0 with MEIDs for 2010-2013, those MEIDs will not match the MEIDs in Release 4.0 for the same years)• Some data may also be more complete• No additional cost
Application Fees
Application Fee Remittance Form for non-government MA APCD and Case Mix requests: http://chiamass.gov/assets/Uploads/apcd-3-0/application-materials/Non-Government-APCD/1.-Fee-Remittance-or-Fee-Waiver-Request-Form.pdf• Reminders:
1. Submit this form with your check
2. Check the appropriate box if you are requesting a fee waiver
3. Note CHIA’s address has changed to 501 Boylston
4. Online payment is not currently an option
Application Revisions
• Please remember to “lock” your application on IRBNet after you’ve finished making revisions to your application
• Locking the application will send an automatic notification to CHIA staff letting them know that your revisions are complete and uploaded
Hard Drives
• Please remember to return your hard drive to CHIA after you’ve loaded your data
• CHIA has a limited number of hard drives, so help us ensure we have a steady supply ready to deliver data to the MA APCD user community
CHIA Enrollment Trends Sourced from the MA APCD
Member Eligibility File
Presented by:
Ashley Storms, Business Lead
Cathy Ho, Technical Lead
Agenda
I. Enrollment Trends Overview
II. Data Specifications
III. Methodology
IV. Data Groupings
V. Challengesi. Methodology Development
ii. APCD Data
VI. Questions
Enrollment Trends Overview
• Recent transition to MA APCD-based enrollment reporting• Analysis based on most recent available Member Eligibility (ME)
submission file• Quarterly enrollment for five time points (March 2014 – March
2015)• Commercial enrollment broken out by:
• Market sector (employer group size) • Funding type (fully- or self-insured)• Product type (e.g. HMO, PPO, Indemnity)
• Public managed care enrollment broken out by program • Commonwealth Care, Medical Security Program (MSP),
MassHealth Managed Care Organization (MCO), OneCare,
Senior Care Options, Medicare Advantage
3
Enrollment Trends OverviewPayer/Program Data SourceCommercial PayersAetna Supplemental ReportAnthem MA APCDBlue Cross Blue Shield of MA MA APCD + Supplemental ReportBoston Medical Center HealthNet MA APCDCeltiCare Health Plan of MA MA APCD + Supplemental Report (MMCO only)CIGNA MA APCDConnectiCare Supplemental ReportFallon Health MA APCD (Public Managed Care Only) + Supplemental ReportHarvard Pilgrim Health Care MA APCDHealth Plans Inc. Supplemental ReportHealth New England MA APCDMinuteman Health MA APCDNeighborhood Health Plan MA APCDTufts Health Plan MA APCDTufts Health Plan -Network Health MA APCDUnited Healthcare MA APCD + Supplemental ReportMassachusetts Public ProgramsMassHealth MassHealthCommonwealth Care MA APCDMedical Security Program MA APCDMedicareMedicare Parts A and/or B CMSMedicare Advantage CMS
Massachusetts Health Care Coverage: Enrollment Trends Technical Notes http://www.chiamass.gov/assets/Enrollment-Trends-Technical-Notes.pdf
4
Enrollment Trends Overview
Massachusetts Health Care Coverage: Enrollment Trends http://www.chiamass.gov/enrollment-in-health-insurance/ 5
Data Specifications
Population of Interest: Massachusetts residents with primary, medical coverage provided by the top 16 commercial payers, MassHealth, and Medicare• MA APCD data used within this report was filed by commercial
payers• Sourced from MA APCD: Enrollment in commercial insurance,
Commonwealth Care, Medical Security Program (MSP), MassHealth Managed Care Organizations (MCOs)
Snapshot Date: Membership as of the last day of each quarter (e.g. 12/31/14)
6
Methodology
A member is considered enrolled if the last day of the quarter (Snapshot Date) is within the Product Enrollment Start Date (ME041) and Product Enrollment End Date (ME042) of the eligibility record (i.e., ME041 ≤ Snapshot Date ≤ ME042). A member record with NULL values for either ME041 or ME042 is considered actively enrolled.
Members are distinguished using the Hash Carrier Specific Unique Member ID (ME107) by Org ID (ME001). A unique member record is selected according to the following criteria, in order of significance:• Subset records by the following:
• Massachusetts resident (ME016 = MA)• Medical coverage (ME018 = 1)• Primary insurance1 (ME028 = 1)
• Where more than one record exists for a member, de-duplicate records in the following order:
1. Funding type2 (ME029)
a. ME029 = (ASO, ASW) for Self-Insured
b. ME029 = (UND) for Fully-Insured
c. ME029 = (STN, OTH) for Other
2. Last activity date (ME056)
3. Member Eligibility ID (Derived-ME05)
1 Include ME028=(3, 4) if the payer stores primary insurance as such in its system.2 This selection hierarchy is to ensure that self-insured plans are given preference over fully-insured plans for members with concurrent enrollment in both self-insured and fully-insured coverage.
7
Data Groupings
COMMERCIAL MARKET
Market Sector APCD Code (ME030)
Individual ME030 = “IND” or “ISCO” or “GCV”
Small Group (1-25) ME030 = “GS1” or “GS2” or “GS3”
Small Group (26-50) ME030 = “GS4”
Mid-Size Group (51-100) ME030 = “GLG1”
Large Group (101-500) ME030 = “GLG2” or “GLG3”
Jumbo-Size Group (501+) ME030 = “GLG4”
Qualified Association ME030 = “GSA”
OtherME030 = “OTH” or “FCH”
Funding Type APCD Code (ME029)
Fully-Insured ME029 = “UND”
Self-Insured ME029 = “ASO” or “ASW”
OtherME029 = “STN” or “OTH”
Product Type APCD Code (ME003)
HMOME003 = “HM”
PPOME003 = “12”
POSME003 = “13”
Indemnity ME003 = “15”
EPOME003 = “14”
Commonwealth Choice ME003 = “CE”
OtherME003 = All else not listed above or
in Public Market Product Types
PUBLIC MARKET
Product Type APCD Code (ME003)
Commonwealth Care ME003 = “CC”
Medicare (Advantage) ME003 = “16” or “20” or “HN”
Medicaid ME003 = “MC” or “MO”
Senior Care Options ME003 = “SC”
Legend
ME003 Insurance Type Code/ProductME029 Coverage TypeME030 Market Category Code
8
Challenges
• Development of methodology• MA APCD data element selection• Subset and de-duplication criteria• Understanding individual payer submissions
• Massachusetts resident (ME016 = MA)• Medical coverage (ME018 = 1)• Primary insurance (ME028 = 1)
• Manual payer-specific modifications / accommodations• Funding Type classifications• Product Type codes
9
Challenges
• Reporting market sector (ME030) changes over time• Employer group size changes may not be reflected in 24-
month rollback
• Membership groups which may not be reported to MA APCD • Host membership• Some self-insured membership• Some public managed care membership
10
Questions?
Ashley StormsHealth System Policy Analyst
CHIA Health System Performance Analytic Team
Cathy HoSenior Health Informatics Analyst
CHIA Health System Performance Analytic Team
Massachusetts Health Care Coverage: Enrollment Trendshttp://www.chiamass.gov/enrollment-in-health-insurance/
User Questions
Question: When analyzing inpatient acute care hospital admissions, the APCD inpatient admission fields do not appear to be well populated. What should I do?
Answer: Filtering by MC036 Type of Bill on Facility Claims = ‘11’ for Inpatient Facility, and MC094 Type of Claim = ‘002’ for Facility and MC027 Entity Type = ‘2’ for non-person entity improves the accuracy in identifying an inpatient admissions.
Code Description Completeness
MC018 Admission Date 100%
MC018 Admission Year 100%
MC018 Admission Month 100%
MC023 Discharge Status 99.3%
MC020 Admission Type 98.5%
MC022 Discharge Hour 93.3%
MC021 Admission Source 91.7%
MC019 Admission Hour 79.7%
Completeness of Inpatient Acute Care Hospital Admission Related Fields after applying MC036, MC094, and MC027 Filters
Also when linking to the provider file by MC076 Billing Provider, the provider attributes can be filtered by PV013 – Entity Code = ’12’ for acute hospital and PV034 Provider ID Code = ‘2’ for Facility)
United States Geographic Distribution of Release 3.0 Eligibility Record Volume
Filter by State if your Project Focuses only on those who Reside in Massachusetts(9.8% of Eligibility Records (24 million) are Outside of Massachusetts)
Count of States = 51Number of RecordsMinimum = 13,479 (AK)Maximum = 227,867,403 (MA)Total Eligibility Records in Release 3.0 = 252,462,501
Questions?
• General questions about the APCD:([email protected])
• Questions related to APCD applications: ([email protected])
• Questions related to Case Mix: ([email protected])
REMINDER: Please include your IRBNet ID#, if you currently have a project using CHIA data
Calendar
• August 25 – Next MA APCD / Case Mix User Workgroup
• August 27 – Data Release Committee Meeting